Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study
Authors: Ranjit Mohan Anjana, Seshadhri Srinivasan, Vasudevan Sudha, Shashank R. Joshi, Banshi Saboo, Nikhil Tandon, Ashok Kumar Das, Puthiyaveettil Kottayam Jabbar, Sri Venkata Madhu, Arvind Gupta, Sarita Bajaj, Subhankar Chowdhury, Sanjay Kalra, Rajagopal Gayathri, Kuzhandaivelu Abirami, Valangaiman Sriram Manasa, Thamotharan Padmapritha, Nagarajan Lakshmipriya, Gunasekaran Geetha, Mohan Deepa, Rajendra Pradeepa, Ranjit Unnikrishnan, Anura Viswanath Kurpad, Kamala Krishnaswamy, Tanvir Kaur, Rupinder Singh Dhaliwal, Viswanathan Mohan, Viswanathan Mohan, Ranjit Mohan Anjana, Ranjit Unnikrishnan, Rajendra Pradeepa, Mohan Deepa, Vasudevan Sudha, Elangovan Nirmal, Radhakrishnan Subashini, Ulagamathesan Venkatesan, L.M. Nath, R.C. Mahajan, K. Ramachandran, M.D. Gupte, R. Lakshmy, Jagadish Mahanta, Kanwar Narain, Sri Venkata Madhu, Ashok Kumar Das, Arvind Pandey, Nikhil Tandon, R.S. Dhaliwal, Tanvir Kaur, Balram Bhargava, P.V. Rao, Modugu Nageswara Rao, Lobsang Jampa, T. Kaki, H.K. Das, P.K. Borah, Ajay Kumar, Smita Sharma, Anil Bhansali, Kalpana Dash, Vijay Kumar Shrivas, Nikhil Tandon, Anand Krishnan, Ankush Desai, Amit Dias, Banshi Saboo, Jayendrasinh M. Padhiyar, Sanjay Kalra, Bharti Kalra, Jatinder Kumar Moktha, Ramesh Gulepa, V.K. Dhandhania, Prabha Adhikari, B. Sathish Rao, P.K. Jabbar, C. Jayakumari, Sunil M. Jain, Gaurav Gupta, Shashank Joshi, Chittaranjan Yajnik, Prashant P. Joshi, Somorjit Ningombam, Th. Bhubhonchandra Singh, R.O. Budnah, M.R. Basaiawmoit, None Rosangluaia, P.C. Lalramenga, Vizolie Suokhrie, Saroj Kumar Tripathy, Nirmal Chandra Sahu, Anil J. Purty, Ashok Kumar Das, Anil Bhansali, Mary John, Arvind Gupta, B. Lal Gupta, Sandeep K. Shrivastava, Karma Jigme Tobgay, Tempo Tsewang Kaleon, Viswanathan Mohan, Ranjit Mohan Anjana, Rajendra Pradeepa, Mohan Deepa, Vasudevan Sudha, Taranga Reang, Swapan Kumar Das, Sarita Bajaj, Manoj Kumar Mathur, Sagar Modi, Rakesh Kakkar, Subhankar Chowdhury, Sujoy Ghosh
Journal: Diabetes Care (2022)

OBJECTIVE To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. RESEARCH DESIGN AND METHODS Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression to T2D in PD and NGT groups. RESULTS Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49–54%; protein, 19–20%; and fat, 21–26%; 2) PD remission to NGT: carbohydrate, 50–56%; protein,18–20%; fat, 21–27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54–57% and 56–60%; protein, 16–20% and 14–17%, respectively; and fat 20–24% for PD and NGT. CONCLUSIONS We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.